Surgery by vaginal approach in stress urinary incontinence: Lahodny bladder suspension

Abstract

Urogenital prolapse and urinary incontinence secondary to multiple defects of the pelvic floor (cystocele caused by lateral and central defect of the pubocervical fascia, hysterocele, rectocele) may also be successfully treated by vaginal approach only. From October ‘95 to September ‘97, 78 women underwent colpohysterectomy, Lahodny bladder suspension and perineoplasty and in 15 of them the vaginal cupola was anchored to the right sacrospinous ligament. In another 3 women Lahodny's procedure was associated with just perineoplasty, since there was a cystocele caused by lateral and central defect of the pubocervical fascia and a rectocele, while the uterus was fixed in place. Prior to operation the 81 patients underwent a colpocytological exam, pelvic ultrasound, a urodynamic exam with flow pressure study and assessment of the leak pressure with Valsalva manoeuvre, and in the cases of constipation or fecal incontinence, coloproctological investigation. The suprapubic catheter that was always positioned at the end of the operation was on average removed on the 10th day, upon the disappearance of significant post-micturitional residue. There is no micturitional difficulty in any patient. Given the short follow-up, the results are given of the 44 women observed for at least one year, 40 of whom are continent. Recurrent prolapse was found in 8 cases, 2 involving the anterior, 40 the rear and 2 the central wall. No patient has had a return of stress incontinence.